It’s not easy to talk about erectile dysfunction (ED), but ED is more common than you think. It affects millions of men. Look around you. There’s a good chance that the guy sitting next to you might have ED, or that the woman across the room is wondering how to help her partner find answers.
Erectile dysfunction (or impotence) is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance.
It is a significant and common medical problem affecting many men worldwide.
In 1995, scientists believe around 152 million men worldwide experienced ED. By 2025, this is expected to reach 320 million.
Causes of erectile dysfunction
An erection is the result of an interaction between the blood circulation system, the nervous system, the hormonal balance and a number of psychological factors. Because this is such a complex mechanism, disruption at any level can result in erectile dysfunction.
Here are some common causes of and risk factors for ED:
- Medical illness – erectile dysfunction is often associated with conditions that affect blood flow in the penis, such as: diabetes, high cholesterol, high blood pressure, cigarette smoking, obesity, heart disease.
- Medications – prescribed medicines used to treat high blood pressure, high cholesterol, depression and psychiatric disorders, and prostate disease, may cause or worsen the symptoms of erectile dysfunction.
- Nerve or spinal cord damage – Interference with nerve function caused by spinal cord trauma, multiple sclerosis, diabetic neuropathy, pelvic surgery, Parkinson’s disease, and Alzheimer’s disease.
- Low testosterone levels– Testosterone (the primary sex hormone in men) is necessary for sex drive (libido) Therefore, men with hypogonadism (low testosterone with symptoms) can have low sex drive and erectile dysfunction.
- Recreational drugs– Recreational drugs, including alcohol, amphetamines, barbiturates, marijuana, nicotine, heroin and cocaine, are associated with erectile dysfunction.
- Urological problems– such as Peyronie’s disease and pelvic trauma.
- Psychological factors – a man’s sexual drive or performance can be affected by stress such as problems at work, relationship difficulties or financial worries. Psychiatric conditions, and feeling depressed or anxious about poor sexual performance can also result in erectile dysfunction.
Erectile Dysfunction Evaluation and Diagnostic Testing
The diagnosis of ED requires a detailed sexual and medical history, physical examination, and laboratory tests.
- Your doctor will ask several questions to determine if your symptoms are suggestive of erectile dysfunction and to assess its severity and possible causes.
- In patients with recognized chronic conditions, the focus will be on a genital exam, and will include cardiovascular examination for cardiovascular risk assessment.
- Laboratory evaluations will assess
- total and bioavailable testosterone
- Luteinizing hormone (LH) and Follicle stimulating hormone (FSH)
- Prolactin levels and estradiol may also be included if the patient has a high body mass index (BMI)
- thyroid hormone
- fasting lipid profile
- liver function studies
- screening for diabetes
- full blood count
- Additional evaluation if indicated could include imaging test such Duplex ultrasonography.
Treatment for erectile dysfunction
Quitting smoking, exercising regularly, losing excess weight, reducing alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve or even prevent progression of erectile dysfunction.
Oral drugs Pills such Viagra, Cialis and Levitra are
first-line medical therapy for ED and
are often prescribed by doctors.
Penile Injections Intracavernosal injections such as Alprostadil
constitute a second line ED treatment
and are often used when oral therapies fail.
Intraurethral A tiny medicated pellet of the drug Alprostadil
medication is placed in the urethra (the tube that transports urine out
of the body).
Topical Cream Topical alprostadil is applied to the tip of the penis and the
surrounding skin. It should be used 5 to 30 minutes before you have
Hormonal Therapy Testosterone Replacement Therapy (TRT)
can be prescribed by your doctor if
low testosterone is detected in blood testing.
Extracorporeal – Non-invasive low-intensity sound waves that pass through
shockwave erectile tissue, restoring natural erectile function by clearing plaque
therapy (ESWT) out of blood vessels and encouraging the growth of new vessels.
Studies have shown its ability to improve and potentially restore
erectile function in men with ED.
Vacuum Erection Popularly known as a penis pump. It consists of a plastic tube
Devices that fits over the penis, a hand or battery-powered pump
attached to the tube, and a band that fits around the base of the
penis once it is erect (constriction ring)
Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions.
Untreated ED can also damage your self–confidence, causing a lot of stress— even depression and anxiety. Many guys with ED feel like their lives are out of their control. The good news is there’s hope. Take back control.